BAL-NEL-78

Code
BAL-NEL-78
Mercy ID
V-03343-01
Encounter Date
06/14/2010
Last
Baltazar
First
Nelida
DOB
10/31/1978
County
Dekalb
Street
2285 Placer Rd. # 7
City
Atlanta
State
GA
Zip
30345-
Cell
(678) 237-6622
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
some high school

Spouse Information

Last
N/A
First
N/A
DOB
N/A
Address
N/A
Telephone
N/A
COB
Mexico
Home Owner
No
Driver
No
Home Owner
No
SOLO
No
Court Mandated
No
Program Completed
No
DFCS Mandated
No
Alcohol & Drug
No
Partner Referred to Tepestri
No
Recidivism/Court
No
New Incident
No
Promesa de Confidencialidad
YES
Consentimiento De Participar
YES

Petitioner

TPO
No
Stay Away Condition
No
Mutual
No

Defendant

TPO
No
Stay Away Condition
No
Mutual
No
Driver
YES
As A Child
No
Relative
No
Stranger
No
As An Adult
No
Partner
No
Relative
No
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Kelly Bailon 05/26/2005 Mother GA/USA
Nelly Bailon 05/26/2005 Mother GA/USA
Valentina Bailon 10/20/1998 Mother GA/USA

Former Spouse 1 Information

Last
Bailon
First
Felemon
DOB
12/17/1974
Telephone
N/A
COB
Mexico
Home Owner
No
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
YES
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
G. Landeros
Data Entry
J. Manzo
Referred By
linea-Juana